Perimenopause is a different experience for each of us, yet there are several common themes and questions. Fortunately, nutrition and lifestyle medicine can be a big help at this time of transition. From hot flushes to anxiety and low mood, making changes to what we eat and how we live can make a powerful difference during perimenopause.


Heavy Periods

Q. My periods are getting heavier and I’m starting to experience a lot more irritability and anxiety. I’ve just turned 41 – could this be perimenopause?

A. Yes. Some of the first signs of perimenopause are changes to moods, period frequency, and/or period flow. These can start happening in your mid to late 30s. However, many women don’t notice this if they’re taking the Pill or using hormonal implants.
Fluctuating oestrogen levels affect our brain just as much as the ovaries and womb lining. There are oestrogen receptors throughout the brain, and each area responds differently to changes in oestrogen levels. For example, if the amygdala doesn’t receive enough oestrogen we can feel more anxious and fearful. If the hypothalamus (our central temperature regulator) is affected we can experience hot flushes.

Try keeping track of your symptoms to see if they fit into any kind of monthly pattern. To help manage the anxiety. follow the tips below in the Q&A for Anxiety & Low Mood.

Heavy periods can increase your iron loss, so be mindful of regularly including iron-rich foods throughout your cycle:

– Haem iron (animal source) is the most bioavailable form for us to absorb and use, and is found in red meat, poultry, fish, and eggs.
– Non-haem iron is found in animal foods too, and also in vegetables – especially dark green leafy veg; pulses, dried fruits, nuts, wholegrains, and Blackstrap molasses. Combine vitamin C rich foods with non-haem iron sources to aid absorption.

Q. My periods are incredibly painful and heavy and I don’t want to take the Pill or have a coil fitted. Do I have to put up with this until after menopause?

A. Symptoms like this can be a sign of fibroids or endometriosis. Both conditions are influenced by oestrogen and hormone fluctuations. During the early stages of perimenopause we can be in a temporary state of oestrogen dominance. Because we stop ovulating every month, there’s very little progesterone produced to counter-balance oestrogen. Unfortunately it can take months, even years, for fibroids or endometriosis to be diagnosed as many doctors fail to recognise how serious the symptoms are. Ask for a referral to a gynaecologist who will be able to offer the right support and testing. It will also be helpful to get your iron levels checked to make sure the heavy periods aren’t depleting your iron stores.


Hot flushes

Q. Hot flushes are keeping me awake every night. I’m feeling exhausted all day, and having difficulty concentrating at work. What can I do?

A. Hot flushes are one of the most distressing perimenopausal symptoms. I can’t promise these tips will get rid of them completely but they can certainly reduce the severity and frequency:

– Minimise caffeine as much as possible. Avoid it altogether if you can! This means tea, coffee, energy drinks, and chocolate. And decaff versions too – sensitive people can react to the trace amounts of caffeine left in decaffeinated drinks.

– Keep your blood sugar levels balanced by eating within 2 hours of waking, replacing refined carbohydrates (white bread, white pasta, cakes, sweets, biscuits etc) with smaller portions of wholegrain versions, and only snacking if there’s a gap of more than 5hrs between meals.

– Try drinking sage tea or taking sage tablets or tincture. The A.Vogel ‘Menosan’ tablets and tincture are a licensed herbal remedy for managing hot flushes and sweats and can help with temperature regulation.

– Relax! Stress is a big trigger for hot flushes. We can’t always make stress go away but we can change how we respond to it. We can do this by building daily downtime into our schedules. This might mean going for a mindful walk, listening to music, following a guided meditation, doing crafts or creative writing, or simply soaking in a bath with essential oils. Mindful relaxation (as opposed to flopping in front of Netflix) is a great way to build our resilience to stress.


Anxiety & low mood

Q. Since starting perimenopause my moods have been really low. I feel anxious and depressed a lot of the time. I’m also really tired. Is this normal?

A. Mood swings and anxiety can be symptoms of perimenopause, but they can also be linked to other conditions. Have you had your thyroid checked? Depression and fatigue can be signs of an underactive thyroid. Many women start to experience thyroid issues around the time of menopause so it’s worth getting your thyroid hormome levels checked with your GP. Ask them to check your levels of TSH (thyroid stimulating hormone), T4 and T3 (thyroid hormones) and thyroid antibodies. The thyroid antibodies are important because an underactive thyroid may be due to auto-immunity. If your results come back positive for underactive thyroid see a Registered Nutritional Therapist for a personalised plan to support thyroid function.

If your thyroid is OK, look at ways to manage the anxiety and depression and low energy:

– Follow the blood sugar balancing tips (see previous Q&A) as poor blood sugar balance can worsen mood swings.

– Include at least 3 servings each day of foods rich in magnesium and B-vitamins such as avocado, sweet potato, nuts, seeds, dark green leafy vegetables, poultry, and eggs. These nutrients are vital for mood balance and energy levels.

– Make sure you’re getting enough sleep. Our brains need 7-9hrs each night, with at least 1 hr of that before midnight. Aim to be in bed by 10.30pm-11pm to give yourself the opportunity for a good rest.

– Include mindful relaxation time each day. Yoga, journalling, mediation, spending time outdoors in natural surroundings, and crafts are all known to be beneficial for managing depression and anxiety.

– Swap regular tea and coffee for herbal teas that soothe and support the nervous system. Lemon balm, chamomile, oat straw, valerian, and lavendar are good options.


Phytoestrogens

Q. I’ve been told to eat phytoestrogens. What are they and where can I find them?

A. Phytoestrogens (phyto = plant) are naturally occurring substances found in fruits, vegetables, and grains. They have a similar effect to human oestrogen, but are hundreds and hundreds of times weaker. They’re not a hormone replacement therapy by any means.  Instead, they have a modulating effect on our fluctuating oestrogen levels and may help reduce hot flushes and offer protection to our bones.

There are 3 types of phytoestrogens. The top food sources include:

  • Isoflavones found mainly in soybeans (edamame) and fermented soy products like tofu and miso. You can also find them in chickpeas, aduki beans, kidney beans, and red clover. Red clover seeds can be sprouted – try sprouting them alongside mung beans and alfalfa seeds.   
  • Lignans flax seed is by far the richest source, followed by sesame seeds, broccoli, and cashew nuts.
  • Coumestans found in mung bean sprouts and alfalfa sprouts. 

Q. Is soy safe to eat? I’ve read so many conflicting things about it!

A. Soy foods certainly are a controversial subject! Unfortunately a lot of the research done on soy uses raw soy extract – not the natural wholefoods recommended for perimenopausal women. The soy foods suggested for perimenopause are the fermented soy products like tofu and miso, and whole cooked soy beans. These foods are part of the traditional diet in Far Eastern countries where women have far fewer menopausal issues. Having said that, no food is entirely suitable for everyone, and some people find soy difficult to digest. If you have any concerns about soy, give yourself peace of mind and enjoy other phytoestrogen foods instead.

I hope you’ve found this Q&A helpful! Watch out for more updates on my forthcoming book “Perimenopause – The Natural Nutrition Guide: What to eat to feel good and stay sane” which will cover all these points and so much more.

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